Usefulness of Preoperative Chemoradiation in Locally Advanced Cervical Carcinoma

Abstract

This study investigated response rate, toxicity, and influence on intra- and postoperative complications of neoadjuvant concurrent chemoradiation in locally advanced (Figo IB2–IIIB) cervical carcinomas. Twenty-eight patients (median age 46.5 years, age range 29–73 years), diagnosed as having squamous cell carcinomas (n = 21), adenocarcinomas (n = 6), and undifferentiated carcinoma (n = 1), entered this study. The chemoradiation protocol included external radiotherapy to the pelvis (39.6 Gy), intra-arterial or intravenous infusion of cisplatin (70 mg/m² on days 1 and 22), and 24-hour continuous intravenous infusion of 5-fluorouracil (700 mg/m² on days 1–4 and 22–25). Two weeks after the end of chemoradiotherapy, the patients underwent restaging followed by suitable operation including pelvic lymphadenectomy. The median follow-up period in the surviving patients was 13.1 months. The response rate for chemoradiation was 93% (26/28). The 2-year disease free survival was 85.2%. Grade 3–4 neutropenia was observed in 14 patients (50%), 4 patients (14%) showed grade 3 anemia, and 5 patients (17.8%) showed grade 3–4 thrombocytopenia. Nineteen patients (67.8%) could undergo surgery after concurrent chemoradiation. Pathological examination revealed a complete response (pT0) in 7 patients, and 5 patients showed only microscopic residual disease (pTmic). In 4 patients, there were intraoperative complications: vesical lesions in 2 (10%) and small intestine lesions in 2 (10%). Neoadjuvant therapy with concurrent chemoradiation for locally advanced cervical carcinoma is effective, safe, and useful for increasing operability rates as well as decreasing intra- and postoperative complications. Therefore, neoadjuvant concurrent chemoradiation should be considered for treatment in patients with locally advanced cervical carcinomas who could not undergo primary operation.

Acute toxicity in cervical cancer HIV-positive vs. HIV-negative patients treated by radical chemo-radiation in Zambia

“…12 Results of the trials by GOG 120, GOG 123 and NCI of Canada, for example, show that study participants at CDH did not experience greater haematological toxicities. The haematological toxicities observed in the CDH study participants were mainly grades 1 and 2, similar to that noted by Singh et al 10 There were no exaggerated severe haematological toxicities of grade 3 and 4 as reported in the study by Shibata et al 12 and the meta-analysis of concomitant chemotherapy and radiotherapy for cervical carcinoma. 13 Cystitis in the CDH study participants became symptomatic after 10-14 days of treatment.…”

Effect of pre‐operative radiotherapy on long‐term outcomes among women with Stage IB1 to IIB cervical squamous cell carcinoma

“…Previous studies have reported that pre‐operative radiotherapy may shrink and downstage the tumor to increase operability rates 19,20 . Another study demonstrated that pre‐operative radiotherapy followed by radical surgery may decrease postoperative intermediate‐risk factors to lessen postoperative adjuvant therapy 21 .…”

Prognostic Impact of Carcinoembryonic Angtigen (CEA) in Locally Advanced Cervical Cancer Treated with Concurrent Chemoradiotherapy

“…All patients gave written informed consent for the treatment. The study design was described in our previous report [8]. The schedule of concomitant chemotherapy was as follows: intraarterial or intravenous infusion of 70 mg·m 2 cisplatin, days 1 and 22; 24-hour continuous intravenous infusion of 700 mg·m 2 5-FU, days 1 -4 and 22 -25.…”